Download Microsoft PowerPoint - From the Crow\222s Nest.pptx

04/10/2013
Objectives:
Identify the etiology of a wound
State 4 different advance wound care products
Colleen Drolshagen RN, CNS, CWOCN
Cadence Health
Central DuPage Hospital
Winfield, IL
List indications for each wound care product
State an advantage and disadvantage for each
wound care product
Never use moistened 0.9 saline gauze in a wound. T_ F_
Dakin’s solution is often used to treat infected malodorous
wounds. T_ F_
3. It is best to stick with one type of dressing when treating a wound
so the family and patient do not become confused. T_ F_
4. Calcium Alginate dressing is an excellent choice for non-draining
wounds. T_ F_
5. Combining different types of products often leads to excellent
outcomes. T_ F_
6. Wash the wound well with hydrogen peroxide when using Santyl, an
enzymatic debriding agent. T_ F_
7. Graduated compression stockings are often a necessary adjunct in
treating venous ulcers T_ F_
8. Moisture associated dermatitis (MASD) may occur on periwound
skin. T_ F_
9.
Off-loading is a key component for healing diabetic foot ulcers.
T_ F_
10. The goal for wound care is always healing. T_ F_
1.
2.
Pre-Test
Treatment of Wounds
Determine the etiology of the wound
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Determine Wound Etiology
Arterial Ulcers
1. Arterial
2. Venous
Tips of toes, foot calf, fingertips
3. Diabetic
Well defined borders
4. Trauma/Surgical
5. Pressure
Pale wound bed
6. Skin tears
7. Moisture Associated Dermatitis (MAD)
Painful
Sleeps with limb hanging down from bed
ABI <.8= Lack of blood flow to the area
Arterial ulcers treatment
Improve blood flow
Address pain
Keep wound bed dry until blood flow is established
Treatment choice may be Povidone-iodine
(confirm pt is not allergic to iodine)
Venous ulcers
Located mid-calf (area covered by a sock)
Poorly defined and jagged wound edges
Wound bed ruddy, copious drainage
Edema
Hemosiderin staining
Dry, scaly skin
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Venous ulcer treatment
Diabetic Ulcers
Address edema
Absorb drainage
Usually on the feet
No pain
compression
Calloused wound edges
Tubigrip stockings in sizes C-F
Diabetic ulcer treatment
Control blood glucose
Establish blood flow
Off-load
Trauma/surgical wounds
Treatment of
traumatic/surgical wounds
Control pain
Manage exudate
Provide moist wound healing principles
Manage infection
Control odor
Protect periwound skin
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Pressure Ulcers
A pressure ulcer is localized injury to the skin
and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in
combination with shear and/or friction.
Stage I Pressure Ulcer
Stage III
Pressure Ulcer
Stage II pressure ulcer
Stage IV Pressure Ulcer
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Unstageable
Purple or maroon localized area of discolored intact skin or blood-filled
blister due to damage of underlying soft tissue from pressure and/or shear. The
area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or
cooler as compared to adjacent tissue. Deep tissue injury may be difficult to
detect in individuals with dark skin tones. Evolution may include a thin blister
over a dark wound bed. The wound may further evolve and become covered by
thin eschar. Evolution may be rapid exposing additional layers of tissue even with
optimal treatment.
NPUAP
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Skin Tears
At risk for skin tears
Well moisturized skin
Treatment of Skin Tears
Minimize dressing changes to decrease
risk of trauma to wound
Most dressings can be left in place for up
to 7 days
Use foam, hydrogel, or non-adherent
gauze (in that order)
Moisture Associated
Dermatitis (MASD
(MASD):
):
Moisture Associated
(MAD)
IrritationDermatitis
and
inflammation associated
with exposure to stool of
urine
Often accompanied by
erosion of the skin
Sometimes accompanied
by a secondary cutaneous
infection (candidiasis)
Etiology and pathology
distinct from a pressure
ulcer
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Protective Barrier
Creams
Urine on the skin
Skin becomes alkaline
Decrease barrier function
Urea
Ammonia
Cavilon
Extra Protective
Further chemical
damage
Wound Care Treatment and
Dressing Selections
Baza antifungal barrier
Transparent Film: Polyurethane or co-polymer
that allows oxygen to pass through membrane.
Smith & Nephew
3M Tegaderm
Indicators: PartialPartialthickness wounds,
Stage II-II pressure
ulcers, superficial
thermal injuries,
donor sites and
debridement
Hydrocolloid Dressings: Hydrophilic
Transparent
Film
Benefits: wound
Disadvantages:
inspection?,
conformable,
promotes autolytic
debridement, and
impermeable to
bacteria. Also can
be used as a
secondary dressing
May
lead to maceration
for periwound tissue,
adhesive may be too
aggressive,
nonabsorptive and
wound exudate may
be mistaken for “pus”
colloid particles
bound together with polyurethane foam. Impermeable to bacteria and has
moderate absorptive capabilities.
DuoDERM By ConvaTec
Comfeel by Coloplast
Indications: Manage pressure ulcers, partial and
full-thickness wounds. Mild exudating wounds, and
wounds with necrosis or slough. Allow 1” border of
intact skin when applying.
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Hydrogels: are water or glycerin-based amorphous gels,
impregnated gauzes or sheet dressings. Maintain a moist wound
Hydrocolloid
Advantages:
Conformable, wear time
3-7 days, comes in
many shapes and sizes,
moderate absorption,
facilitates autolytic
debridement, thermal
insulation and pain
reduction. Can be used
to protect skin from
frequent tape removal.
environment.
Disadvantages: Does
not accommodate
wounds with infections,
tunnels, sinus tracts,
or heavily draining
wounds. May leave a
residue and a
distinctive odor upon
removal. Dressings
edges may curl. If
opaque, unable to see
wound bed. May cause
hypergranulation tissue.
Southwest
Technology Elastogel
Sytagenix Wound management
Indications: Manage partial and full-thickness
wounds, Stages II-IV, thermal injuries,
radiation dermatitis, and wounds with necrosis
and slough.
Foam: Hydrophilic polyurethane/polymer or gel-coated
foam, non-adherent, absorptive dressing
Hydrogels
Advantages: Non-
adherent, rehydrates
the wound bed, better
alternative to saline
gauze dressing,
available as gels,
sheets, strips and
gauze. Aids in autolytic
debridement.
Disadvantages: May
macerate periwound
skin, daily dressing
changes may be
required, may need a
secondary dressing,
not recommended for
heavy exudate
Molnlycke
Border Sacrum
Smith and Nephew Alleyvn Foam
Indications: Stage II-IV, partial and full-
thickness wounds, moderate-heavy exudate,
primary or secondary dressing. Also, one
dressing of choice to treat hypergranulation
tissue.
Use of foam tip:
Foams
Advantages: adherent
or nonadherent
available, may be used
under multi-layer
compression wraps,
conformable, available
as sheets, pads, and
cavity dressings. May
stay on for up to 7
days.
Disadvantages: not
effective for wounds
with dry eschar, may
require a secondary
dressing, may macerate
periwound skin.
Caution with use on
infected wounds.
adhesive border
non-adhesive border
Use 6x6 or 3x3 adhesive border for sacral, and
coccyx pressure ulcers and skin tears
Cut the 8x8 non-adhesive border to fit under
trach plates or may use on skin tears with a
secondary dressing to hold in place
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Calcium Alginate: Highly absorptive product
derived from brown seaweed.
ConvaTec Kaltostat
Calcium
Advantages: Alginate
Absorbs
Disadvantages: may
3M
Tegagen
Indications: Manage draining wounds with
up to 20 times its
weight, reduces
frequency of dressing
changes, conformable,
easy to apply and
remove, trauma free
removal
moderate to heavy exudate, partial and
full-thickness wounds, tunneling, infected,
and noninfected wounds, donor sites and
assist with hemostasis.
desiccate wound bed,
some forms may leave
fiber in the wound bed,
contraindicated for dry
eschar, full-thickness
thermal injury, may
require a second
dressing to secure
Collagens: major protein in the body, it stimulates cell
migration, and formation of granulation tissue. Available in
sheets, pads, particles, and gels.
Smith and Nephew
Biostep
Medline Puracol
Indications: partial and full-thickness
wounds, infected and non-infected wounds,
tunneling wounds, minimal to heavy exudate
skin grafts and donor sites.
Collagens
Advantages:
absorbent, maintains a
moist healing
environment, conforms
easily, easy to apply
and remove, change 17 days, daily if
infection present
Contact Layers: a single layer of woven net that acts a as lowadherent material when applied to the wound bed. This material
allows wound exudate to be passed to a secondary dressing.
Disadvantages:
contraindicated for
full-thickness thermal
injury, presence of dry
eschar, and those
sensitive to
collagen/bovine
products. May require
rehydration Requires a
secondary dressing.
Hollister
Restore
Molnlyke Healthcare Mepitel
Indications: May be used as a primary
dressing for partial and full-thickness wounds,
minimal to heavy wound exudate, donor sites,
and split-thickness grafts.
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Contact
Layer
Advantages: May
be
Disadvantages: Not
applied with topical
medications, fillers, or
gauze dressings.
Protects trauma of
wound bed upon dressing
changes. May be used in
negative pressure wound
therapy to decrease pain
and trauma to wound bed
recommended for stage
I pressure ulcers,
tunneling wounds,
dehydrated or eschar
covered wounds, or
wounds draining viscous
exudate. Usually
requires a secondary
dressing
Gauze Dressings: available in many forms,
woven and nonwoven, impregnated, and
nonadherent
Kendall Kerlix Roll
Medline gauze sponge
Indications: (vary with individual gauze products)
Wounds requiring debridement, packing, management
of tunneling, tracts or dead space, surgical incisions,
thermal injury, partial and full-thickness wounds, and
pressure ulcers.
Gauze
Advantages:Dressings
can be used Disadvantages: May
on infected wounds with
topical medication,
conformable and
effective as a packing
agent, easy to apply,
available in many sizes
and shapes, may have
absorptive and wicking
action, and provide
mechanical debridement.
Saline gauze dressings
Moist to moist
Wet to dry
interfere with wound
healing if not changed
often enough or changed
too often, fibers may
shed and adhere to
wound bed, more likely
to cause pain if not
removed properly, may
not be the most
effective moist wound
healing therapy
Impregnated Gauze Dressings
Hypertonic Saline (Mesalt)
Petroleum (Vaseline gauze)
Anti-microbial (Kerlix AMD)
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Antimicrobial Dressings may contain silver, methylene
blue, iodine, or active Leptospermum honey
Medihoney made from the
manuka plant in New Zealand
Sterile honey that provide an acidic environment for wound
helaing
Assists to debride wounds
“Jump starts” a stalled wound
Smith and Nephew Aticoat
Hollister Hydroferra Blue
Smith and Nephew
Iodof
Derma
Sciences
Medihoney
Indications: For use in draining, infected, or
Can be used on infected wounds
Can be left in place up to 7 days
Confirm pt is not allergic to honey
Colloid
nonhealing wounds. May manage various types
of acute and chronic wounds including thermal
injury, diabetic, pressure, and vascular ulcers
Paste
Antimicrobial
Dressings
Advantages: Provides a
Disadvantages: May
broad range of
antimicrobial or
antibacterial activity.
Can reduce or prevent
infection. Can “kick
start” the wound healing
process.
cause staining in wound
and on intact skin. May
cause stinging sensation.
Must remove silver
dressing for a magnetic
resonance imaging (MRI)
testing. Development of
resistant organisms?
Drugs: prescription products that provoke a
series of physiochemical events in the body
that assists with wound healing
Healthpoint Xenaderm
Increase blood flow, improve epithelialization and aid in
reduction of pain.
Indications: Varies by product
Negative pressure therapy: localized negative pressure
that removes interstitial fluid, infectious material, and
promotes granulation tissue formation.
Healthpoint Regranex
(becaplermin) Gel 0.01%
KCI Wound
V.A.C.
Avoid silver and
iodine products and
apply ~ a nickel
thick
Smith and Nephew
Renasys Go
Blue Sky
Versatile 1
Indications: Acute and chronic wounds,
traumatic wounds, partial-thickness thermal
injury, dehisced wounds, flaps ,grafts, enteric
fistulas
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Negative
Pressure
Therapy
Advantages: M-W-F
Disadvantages:
Needs
dressing changes or
every 48 hrs, decreases
edema and bacterial
colonization, encourages
epithelial and cell
migration
special supplies and
training, contraindicated
for unexplored fistulas,
necrotic tissue with
eschar, wounds with
malignancy, untreated
osteomylitis, and over
exposed organs or blood
vessels. Can be painful
with dressing removal.
Nutrition
Multivitamin
Adequate calories
Protein
Zinc (if deficient)
Nutrition
Pre-albumin is the best indicator of nutritional
adequacy. Normal Prealbumin: 16 to 35 mg/dl
Increased Prealbumin: Alcohol abuse, corticosteroids
Decrease Prealbumin: Zinc deficiency, inflammation
Infection
Increase pain
Wound healing stalled
Increased drainage
Increase odor
Increase WBCs
Erythema notes on periwound skin
Culturing a Wound
Prior to culturing the wound:
1. Remove old dressing
2.
Cleanse wound with normal saline or commercial wound cleanser to remove old drainage
3.
Obtain culturette to perform wound culture
4.
When culturing the wound, apply sufficient pressure and perform a 10-point sweep across
the wound bed to cause tissue fluid to be expressed
(It is the bacteria in the tissue fluid that is desired for culture)
If the wound has any tunneling or undermining, obtain an anaerobic culture as well
5.
Example of
10-Point Sweep
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Malodorous wounds
The most important step in determining dressing
selection for those patients with chronic non-healing
wounds is:
Goal is to decrease the anaerobic activity
Topical and oral metronidazole
A. Cost of the product
B. Identifying wound etiology
Medihoney
Silver
¼ Strength Dakin’s (protect periwound skin with
a moisture barrier)
In the patient with a highly exudating wound,
which category of dressing wound be most
appropriate?
A. Transparent dressings
B. Hydrocolloids
C. Collagens
D. Alginates
In conclusion remember every
wounds is
C. Preference of the wound clinician
D. Availability of the product
Avoid the use of enzymatic deriding agents and
hydrogen peroxide when utilizing dressings
containing silver.
True
False
Questions
Unique
Ever changing
Dynamic
Each wound should be assessed accordingly and
your treatment will change as the wound changes
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References
Bryant, R, Nix, D. Acute & Chronic Wounds, Current
Management Concepts. 2007
Gray, Mikel, et al. Moisture-Associated Skin Damage:
Overview and Pathophysiology, JWOCN, May/June,
2011
Hess, C.T. Clinical Guide: Wound Care 6th ed.
Springhouse Pa.: Springhouse Corp.,2008
Thank You
14
From the Crow’s Nest: Topical Wound Care and Dressing Selection
Colleen Drolshagen RN, CNS, CWOCN
I. Identification of wound etiology.
a.Pressure
b. arterial
c. venous
d. diabetes
e. skin tears
f. moisture associated dermatitis
II. Advance wound care products
1. Foam
2. Calcium alginate
3. Contact Layer
4. Antimicrobial dressings
5. Other
IV.Indications
A. Foam
1.
Indications: Stage II-IV, partial and full-thickness wounds, moderate-heavy exudate, primary or secondary
dressing. Also, one dressing of choice to treat hypergranulation tissue.
B. Calcium Alginate
}
Indications: Manage draining wounds with moderate to heavy exudate, partial and full-thickness wounds, tunneling,
infected, and noninfected wounds, donor sites and assist with hemostasis.
C. Contact Layer
}
Indications: May be used as a primary dressing for partial and full-thickness wounds, minimal to heavy wound
exudate, donor sites, and split-thickness grafts.
D. Antimicrobial dressings
}
Indications: For use in draining, infected, or nonhealing wounds. May manage various types of acute and chronic
wounds including thermal injury, diabetic, pressure, and vascular ulcers
E. Others
Pre-test
1. Never use moistened 0.9 saline gauze in a wound. T_ F_
2. Dakin’s solution is often used to treat infected
malodorous wounds. T_ F_
3. It is best to stick with one type of dressing when
treating a wound so the family and patient do not become
confused. T_ F_
4. Calcium Alginate dressing is an excellent choice for nondraining wounds. T_ F_
5. Combining different types of products often leads to
excellent outcomes. T_ F_
6. Wash the wound well with hydrogen peroxide when using
Santyl, an enzynmatic debriding agent. T_ F_
7. Graduated compression stockings are often a necessary
adjunct in treating venous ulcers T_ F_
8. Moisture associated dermatitis (MASD) may occur on
periwound skin. T_ F_
9. Off-loading is a key component for healing diabetic foot
ulcers. T_ F_
10. The goal for wound care is always healing. T_ F_